Advancing Pathology Informatics, Imaging, and the Internet (APIII 2000)
Archives of Pathology & Laboratory Medicine · 2001
John Coers; Jon Nichols; MARK WHITNEY ([email protected]); Jay Wile. Pathologists Associated Medical Laboratories, Muncie, Ind.BACKGROUND: Our clients are geographically dispersed across all of east-central Indiana, making direct communication difficult. However, timely communication of test requisitions and rapid turnaround of test results are key factors in maintaining client satisfaction and successfully competing against much larger laboratories. In 1997, we set out to create the infrastructure and applications that would serve as a foundation for providing clients with simple and secure Internet-based access to our services and information. We forged ahead despite the fact that we did not have a million-dollar budget or dozens of staff people, as did our much larger competitors. We relate our experiences and demonstrate our progress to show that small and midsized laboratories can successfully compete on the Internet playing field.DESIGN: The key to the design was to break the project into small, realistically achievable units that join to form a much larger whole. The central component of our infrastructure is a structured query language (SQL)-based data warehouse capable of receiving data from multiple sources, storing the data long term, and responding quickly to queries for data. Applications are built on a multitier model consisting of a Web-based user interface, an Intranet or Internet host acting as a “middleware” transaction server, and the data warehouse supplying the data.RESULTS: Our first application was at a client beta site in less than a year and went live in only 14 months. The entire system was designed and built by 3 people while they continued other network and programming duties. The cost of hardware and software for this initial phase was less than $50 000. We have continued to upscale the system and add more applications during the past 2 years. The data warehouse now contains more than 13 000 000 clinical and anatomic test results available to our clients via the Internet.CONCLUSION: The growing acceptance of the Internet as a standard method of information exchange combined with the low cost of entry into this arena provides a unique opportunity for laboratories of any size to gain competitive advantages in the marketplace.GREGORY J. BUFFONE, PHD ([email protected]). Baylor College of Medicine, Texas Children's Hospital, Houston, Tex.CONTEXT: Examinations are useful in assessing student competency before and after instruction, as a supplement to traditional means of instruction when associated with immediate feedback to the student, and for documenting preceptor performance and educational outcomes. Internet-based systems can provide the flexibility and simplicity to aid in delivering examinations, automating variation in administration methods, and tracking results.OBJECTIVE: The ExamNet application was developed to assist preceptors in creating, administering, and tracking student competency via examination. ExamNet is a Web-based system that provides the preceptor with the capability to author questions (classified using MeSH terms and medical categories), compile a quiz or quizzes, and publish and administer a quiz or quizzes, as well as track student activity without any technical knowledge of hypertext markup language (HTML), scripting languages, or Internet technology.DESIGN: Questions and/or answers may include one or more images, as well as audio files or video clips. A quiz may be administered in one of 3 modes: questions only, question immediately followed by answer, or completion of all questions followed by a review of answers for all questions.The site and application are structured to provide services for multiple preceptors working independently or in collaboration. The application recognizes 4 types of users—students, authors, curriculum administrators, and system administrators. Curriculum administrators may author and upload site content pertinent to their academic program in addition to authoring questions and quizzes. Initial use of ExamNet will be in educational research.The application was written using Visual Basic Script (VBScript) and JavaScript and requires Access and Microsoft Internet Information Server version 4.0 for implementation.CONCLUSION: This presentation will cover design philosophy, application and physical architecture, and utility and application of the system, as well as examples of its use in pathology and ambulatory medicine education projects.http://www.geocities.com/wshang/WILLIAM SHANG, MD ([email protected]). A. O. Fox Hospital, Oneonta, NY.CONTEXT: The confluence of an increased surgical pathology workload, an administration's uncertain purchasing timetable, and the availability of a relatively easy-to-program, Microsoft Access 97, resulted in implementation of Integrity in 1998.OBJECTIVE: The pathologist-author desired to build a full-featured, open-architecture anatomic pathology database system suitable for a small practice.DESIGN: The day's demographic input is transferred in a flat-form text file from the hospital's laboratory information system (LIS). Computer-generated free-form gross, diagnosis, and microscopic text is pasted from a commercial continuous speech-recognition program (Dragon Naturally Speaking). Routine diagnoses can be created by a few mouse clicks from customizable diagnosis/microscopic templates in a drop-down menu. Cytologists create Bethesda-based reports from an established diagnostic menu. The release of surgical reports coincides with the sign-out for each report.SETTING: The principal advantages of an open-architecture system include the ability to create customized queries and reports without the hindrance, added expense, or delay of a third-party vendor. The system operates on a local area network (LAN) of 7 simultaneous users.RESULTS: More than 100 000 reports have been archived in a stable environment since the inception of the database. All created reports can be retrieved in fully formatted text, viewable in a separate window linked by medical record number at the time of sign-out or later.One quarterly run form correlates all subsequent anatomic studies after an index abnormal Pap smear, allowing rapid determination of adequacy of follow-up. 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